Consensus Report on the Detailed Fetal Anatomic Ultrasound Examination

Wax, Joseph R.; Minkoff, Howard; Johnson, Anthony; Coleman, Beverly G.; Levine, Deborah; Helfgott, Andrew; O’Keeffe, Daniel; Henningsen, Charlotte; Benson, Carol B.

doi:10.7863/ultra.33.2.189

Cited by 74 publications

(30 citation statements)

References 62 publications

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“…Eddleman et al17 found that routine nontargeted ultrasound detected none of their 82 cases of VCI at delivery in a four-year period. More recent guidelines from the AIUM recommend identification of the PCI, when possible, on the basic fetal anatomy survey, and PCI identification is now considered to be an integral component of the detailed (targeted) fetal anatomy survey 18. The number of VCI cases identified subsequent to publication of the 2014 AIUM guidelines was small.…”

Section: Discussionmentioning

confidence: 99%

<p>Accuracy of fetal anatomy survey in the diagnosis of velamentous cord insertion: a case–control study</p>

Curtin

Hill

Millington

et al. 2019

IJWH

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ObjectiveOur objective was to determine the accuracy of ultrasound at the time of the fetal anatomy survey in the diagnosis of velamentous cord insertion (VCI).Study designThis retrospective case–control study identified placentas with VCI (cases) and randomly selected placentas with normal placental cord insertion (PCI) (controls) as documented by placental pathology for mothers delivered from 2002 through 2015. Archived ultrasound images for PCI at the time of the fetal anatomy survey were reviewed. Data analysis was by calculation of sensitivity, specificity, and accuracy and their 95% CI for the ultrasound diagnosis of VCI.ResultsThe prevalence of VCI was 1.6% of placentas submitted for pathologic examination. There were 122 cases of VCI and 347 controls with normal PCI. The performance criteria calculated for the diagnosis of VCI at the time of fetal anatomy survey were as follows: sensitivity 33.6%; 95% CI: 25.3, 42.7; specificity 99.7%; 95% CI: 98.4, 99.9 and accuracy 82.5; 95% CI: 80.5, 82.9.ConclusionThe identification of a VCI at the time of fetal anatomy survey is highly specific for the presence of a VCI as documented by placental pathology. The sensitivity in this study was less than expected. Sensitivity could be improved by reducing the number of nonvisualized PCIs, creating an awareness of risk factors for VCI, and obtaining more detailed images in the case of an apparent marginal PCI.

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Section: Discussionmentioning

confidence: 99%

<p>Accuracy of fetal anatomy survey in the diagnosis of velamentous cord insertion: a case–control study</p>

Curtin

Hill

Millington

et al. 2019

IJWH

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“…Here we use the terms “basic” and “detailed” to refer to current procedural terminology (CPT) codes 76805 and 76811, respectively. 1 …”

Section: Methodsmentioning

confidence: 99%

“…The American Institute of Ultrasound in Medicine (AIUM) and the Society of Maternal-Fetal Medicine have issued a joint statement that describes what constitutes a basic (76805) and detailed (76811) fetal anatomic examination. 1 This statement also asserts that physicians performing or interpreting the detailed fetal anatomic ultrasound must be appropriately trained obstetricians, maternal-fetal medicine specialists, or radiologists with special expertise in fetal imaging, or they must maintain a log demonstrating that they have participated in the scanning and interpretation of at least 100 detailed fetal anatomic scans including at least 25 fetal cases with major morphologic abnormalities. 1 However, what constitutes appropriate physician training has not been recently described.…”

mentioning

confidence: 99%

“… 1 This statement also asserts that physicians performing or interpreting the detailed fetal anatomic ultrasound must be appropriately trained obstetricians, maternal-fetal medicine specialists, or radiologists with special expertise in fetal imaging, or they must maintain a log demonstrating that they have participated in the scanning and interpretation of at least 100 detailed fetal anatomic scans including at least 25 fetal cases with major morphologic abnormalities. 1 However, what constitutes appropriate physician training has not been recently described. 2 The MFM specialty training is broad and has several components which have competing interests on the time commitment of the MEM fellows.…”

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confidence: 99%

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Structured Training for Fetal Diagnostic Skills in a Maternal-Fetal Medicine Fellowship

Antony

Khurshid

Trampe

et al. 2018

AJP Rep

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Objective The American Institute of Ultrasound in Medicine has described what constitutes a detailed fetal anatomic examination but what comprises an appropriate physician training program has not been described. The purpose of this paper is to describe a highly-structured program developed by our center to train maternal-fetal medicine fellows in a systematic approach to fetal diagnostic imaging. Study Design We describe this approach in three phases. Phase I: Development of Skills as a Perinatal Sonographer, Phase II: Mentored Evolution to a Perinatal Sonologist and Phase III: Supervised Independent Practice as Consultant-in-training. Results This curriculum was implemented in 2006. Of the eight maternal-fetal medicine fellows who completed this program, 100% were capable of following this curriculum and 100% felt comfortable performing and interpreting detailed sonograms including sonograms with significant and uncommon anomalies. Qualitative feedback was also positive. Finally, this structured approach resulted in an increase in the average total number of sonograms interpreted. Conclusion Our curriculum, by following the explicit guidelines and expectations set out by the American Institute of Ultrasound in Medicine and the American Board of Obstetrics and Gynecology for practicing maternal-fetal medicine fellowship graduates, provides an opportunity to explore national standardization for this component of training.

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“…Nearly any organ system can be affected, including complex cardiac defects, central nervous system anomalies, urogenital lesions, and skeletal malformations, such as caudal regression sequence . Because of this increased risk, the American College of Obstetricians and Gynecologists, Society for Maternal‐Fetal Medicine, and American Institute of Ultrasound in Medicine recommend specialized sonography with a detailed anatomic survey and fetal echocardiography for screening in women with pregestational diabetes …”

mentioning

confidence: 99%

Fetal Anomaly Detection in Pregnancies With Pregestational Diabetes

Martin

Duryea

McIntire

et al. 2020

J of Ultrasound Medicine

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Objectives-To evaluate fetal anomaly detection in pregnancies with pregestational diabetes, according to the gestational age at the time of specialized sonography, use of follow-up sonography, maternal body mass index, and organ system(s) involved. Methods-Women with pregestational diabetes who received prenatal care and delivered a live-born or stillborn neonate at our hospital from October 2011 through April 2017 were ascertained. We included all pregnancies with at least 1 confirmed structural anomaly (EUROCAT classification) who had detailed sonography at 18 weeks' gestation or later. We analyzed detection of anomalous fetuses at the initial detailed sonogram and, if no abnormality was identified, during any follow-up sonograms. Statistical analyses were performed with the χ 2 test and Mantel-Haenszel χ 2 test for trend. Results-Seventy-two anomalous neonates (72 of 1060 [6.8%]) were born. Overall detection was 55 of 72 (76%); 49 of 72 (68%) were detected at the initial detailed sonogram, compared to 6 of 15 (40%) of follow-up examinations (P = .04). Recognition at the initial or follow-up examination was not dependent on gestational age or body mass index category (all P > .05). Of individual organ system anomalies, 67 of 89 (75%) were identified. Detection exceeded 85% for central nervous system, genitourinary, and musculoskeletal abnormalities and 43% for craniofacial anomalies. Sixty-five percent of cardiac anomalies were detected, and 14 of 17 (82%) requiring specialized care in the immediate neonatal period were recognized. Conclusions-Approximately three-fourths of anomalous fetuses were identified, with greater detection at the initial detailed examination. Fetuses with central nervous system, genitourinary, musculoskeletal abnormalities and those with cardiac anomalies requiring specialized cardiac care were more likely to come to attention.

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Consensus Report on the Detailed Fetal Anatomic Ultrasound Examination

Cited by 74 publications

References 62 publications

<p>Accuracy of fetal anatomy survey in the diagnosis of velamentous cord insertion: a case–control study</p>

<p>Accuracy of fetal anatomy survey in the diagnosis of velamentous cord insertion: a case–control study</p>

Structured Training for Fetal Diagnostic Skills in a Maternal-Fetal Medicine Fellowship

Fetal Anomaly Detection in Pregnancies With Pregestational Diabetes

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Consensus Report on the Detailed Fetal Anatomic Ultrasound Examination

Cited by 74 publications

References 62 publications

<p>Accuracy of fetal anatomy survey in the diagnosis of velamentous cord insertion: a case&ndash;control study</p>

<p>Accuracy of fetal anatomy survey in the diagnosis of velamentous cord insertion: a case&ndash;control study</p>

Structured Training for Fetal Diagnostic Skills in a Maternal-Fetal Medicine Fellowship

Fetal Anomaly Detection in Pregnancies With Pregestational Diabetes

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Product

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<p>Accuracy of fetal anatomy survey in the diagnosis of velamentous cord insertion: a case–control study</p>

<p>Accuracy of fetal anatomy survey in the diagnosis of velamentous cord insertion: a case–control study</p>